The NMC will take a “proactive” hard line against nurses and nurse leaders who neglect patient care, the regulator’s new chief executive has told Nursing Times.
Dickon Weir-Hughes said the Nursing and Midwifery Council should investigate trusts if it suspects problems and, where concerns were justified, suspend their training role and strike staff off the register.
He said: “One of the myths that’s worth shattering is that there has to be a complaint to the NMC for something to be done, because there doesn’t and that is clearly set out in legislation.”
The new approach will include action against scandal-hit trusts, which in the past the NMC has left to other regulators.
Investigations can be prompted by anything that “creates a concern” and Professor Weir-Hughes said they should be triggered where several sources – such as press reports and complaints – suggest there is a problem.
It has happened only once in the past - at North West London Hospitals Trust in 2005. That inspection, prompted by a damning Healthcare Commission report on maternity services, resulted in trainees being removed.
Professor Weir-Hughes plans, if necessary, to investigate trusts much more often. He wants to be alerted when the Care Quality Commission, the health and social care “super regulator”, suspects poor nursing care. Inspectors from both would visit trusts together and decide what action should be taken.
“We’d really like to be in there at the beginning with the CQC rather than on the back foot,” Professor Weir-Hughes said. The NMC is seeking to agree a “memorandum of understanding” with the CQC.
Professor Weir-Hughes particularly emphasised the responsibility of nurse leaders and managers to tackle poor care and, if they can’t, to report it.
He said: “The bottom line is nurses and midwives are expected to make care of patients their first priority regardless of where they are in the hierarchy.”
Professor Weir-Hughes stressed there were many ways of raising concern such as filling out risk forms or, for a nursing director, formally telling the board and contacting regional nursing directors.
He said: “There are tons of ways people can adhere to the code without doing something they might consider unorthodox or too radical.
“If they have major concerns about staffing levels and didn’t feel they were being adequately listen to there are steps they could take.”
Professor Weir-Hughes said he would like the NMC “recognised for the support we provide to nurses and midwives”, and said investigation reports would highlight good practice as well as any problems.
Julie Hendry, who joined Mid Staffordshire Foundation Trust as interim nursing director in November, eight months after it was criticised for “appalling” care – much of it related to nursing – by the Healthcare Commission, the CQC’s predecessor, said a more proactive approach would be welcome.
The NMC did not investigate the trust. Ms Hendry said: “For some nurses the most they have to do with the NMC is when they register. So an approach where they come into organisations and advise, support and challenge would be welcome.
“When things do go horribly wrong they [the NMC] should be in the organisation – it would be useful to have their professional perspective.”
Council for Healthcare Regulatory Excellence chief executive Harry Cayton welcomed the change as a significant move towards better checks on quality of care.
He said: “We think regulators should be more active in working with employers to identify areas of weakness.”
Unison head of nursing Gail Adams said although she recognised the NMC’s legal responsibility, her “slight reservation” was that many of these cases were failures of the system rather than individual registrants.
“While I recognise nurses and midwives have a duty to make sure they’re raising concerns about poor standards of care, things might be preventing them doing the job in the way they would wish, and from raising concerns.
“We need to make sure there’s a clear framework in place for them to do that, and when concerns are raised, they are listened to and acted upon.”
Ms Adams said she did not believe nurse leaders would not have questioned staff shortages. “There is no nurse or nurse leader I now who is going to say, ‘Yes let me give up part of my workforce,’ without making an argument.”
A CQC spokeswoman said: “The CQC meets regularly with the NMC to discuss the continued benefits of a working relationship and how it can progress, this includes the development of a memorandum of understanding.”